HomeMy WebLinkAboutMortgage_Sheridan (2) M.n4Q. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ED y Township Year
e__._-- FOR DEDUCTION FROM ASSESSED VALUATION Y��i' Sate Form 43709(R12/6-14)
\ ,' Prescribed by Department of Local Government Finance F - —
INSTRUCTIONS: • File Mark
To be filed in person or by mail. JAN 115 2016 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be fled or postmarked with the County Auditor or County Recorder of the c•unty wh- - t •• is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ' q,mai ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with th- l pt.1:ii.• . • - •�y1ty
where the property is located during the twelve(12)months before Mard61B$Mk * .. • r Sought. '•
See reverse side for additional instructions and qualifications.
A pli (owner or ntr ct buyer-see restrictions n revers ide) a n •
Taxies Key numb /legal description Rem numb/ Page,nymber
r . Qlo -i2 -o& -a03 -oo/. aS7-oar QO/fP !/co
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1.anent year March 1,current year ,�--,,,�""11 date of application legal or equitable owner?
/7 O
I 00.6!/ ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgage p�yJr�ntract seller / / ,
1P-)27112 Ctin Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? I Has this deduction been requested_ 1 If yes.state.amount of deduction
other county - - -
in Indiana? ❑Yes LI No C+
A person is not entitled to this deduction unless the person has a balance on the per Shen e n -l n/1 /V7 a*LJ-ci ded in the county
recorder's office(including any home equity line of credit that is recorded in the tour, cJ Y 1 , !!1 v r I . 1 4�� �.
COUNTY AUC 5 500 Wit�n p
Deduction approved in the amount of: ///�j,JO ��1 i[/� (1
20 20 20 20 �/ rpi Ly r {\me f(en 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signatur wnef II m Date(month,day,year)
!//)711/6
Ful ' ent dress a icant( mbar and street.city state,and ZIP code)
erson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S 10,000.